Journal Article

Rating scales for dystonia in cerebral palsy: reliability and validity

DEKLERCK, J, ROELENS, F, FEYS, H, DE COCK, P, MONBALIU, E, ORTIBUS, E, DESLOOVERE, K, PRINZIE, P

2010

Overview

Aim  This study investigated the reliability and validity of the Barry–Albright Dystonia Scale (BADS), the Burke–Fahn–Marsden Movement Scale (BFMMS), and the Unified Dystonia Rating Scale (UDRS) in patients with bilateral dystonic cerebral palsy (CP). Method  Three raters independently scored videotapes of 10 patients (five males, five females; mean age 13y 3mo, SD 5y 2mo, range 5–22y). One patient each was classified at levels I–IV in the Gross Motor Function Classification System and six patients were classified at level V. Reliability was measured by (1) intraclass correlation coefficient (ICC) for interrater reliability, (2) standard error of measurement (SEM) and smallest detectable difference (SDD), and (3) Cronbach’s alpha for internal consistency. Validity was assessed by Pearson’s correlations among the three scales used and by content analysis. Results  Moderate to good interrater reliability was found for total scores of the three scales (ICC: BADS=0.87; BFMMS=0.86; UDRS=0.79). However, many subitems showed low reliability, in particular for the UDRS. SEM and SDD were respectively 6.36% and 17.72% for the BADS, 9.88% and 27.39% for the BFMMS, and 8.89% and 24.63% for the UDRS. High internal consistency was found. Pearson’s correlations were high. Content validity showed insufficient accordance with the new CP definition and classification. Interpretation  Our results support the internal consistency and concurrent validity of the scales; however, taking into consideration the limitations in reliability, including the large SDD values and the content validity, further research on methods of assessment of dystonia is warranted.

• Publisher: Blackwell Publishing Ltd,Wiley-Blackwell,Mac Keith Press
• Subject: Adolescent / Cerebral Palsy / Cerebral Palsy - complications / Cerebral Palsy - diagnosis / Child / Child, Preschool / Classification / Content Analysis / Content Validity / Correlation / Disability Evaluation / Dystonia - complications / Dystonia - diagnosis / Error of Measurement / Evaluation Methods / Female / Humans / Interrater Reliability / Male / Measurement Techniques / Measures (Individuals) / Motor Reactions / Neurological Impairments / Observer Variation / Patients / Rating Scales / Reliability / Scores / Severity of Illness Index / Statistical Analysis / Validity / Young Adult